Job Description

Job Title: Team Leader, Claims- Medicaid
Job ID: 619009
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day
Facility:
Department: Community HealthChoices
Location: 1650 Metropolitan Street, Pittsburgh PA 15233

Description

Purpose:
Are you a dynamic leader with a strong background in health insurance claims? If so, the position of Team Lead, Claims may be the perfect fit for you.  In this role you will provide technical and plan support to claims examiners and adjustment/COB staff while assisting with development and training of the team members.  Additionally, this role is responsible for processing VIP claims and adjustments while resolving customer concerns as needed. If this sounds like the ideal next step in your career, apply today!

Responsibilities:
  • Assist other departments as requested during periods of backlogs.
  • Assist with inventory control measures.
  • Assume supervisory responsibility in the absence of the supervisor.
  • Complete special projects as assigned.
  • Identify and participate in the training needs of team members.
  • Maintain employee and insured confidentiality.
  • Participate in the development/refinement of policies and procedures.
  • Perform system demonstrations for prospective/existing clients.
  • Process claims and/or adjustments.
  • Provide technical support to team members.
  • Research and respond to both external and internal inquiries in a timely manner.
  • Support cross-functional team members to meet or exceed quality and production designated standards.

Qualifications

  • Bachelor's degree or equivalent education and experience.
  • Five years health insurance, medical claims processing, claim adjustment; coordination of benefits, and/or customer service experience required with a minimum 3 of those years Managed Care, Benefit Administration, PPO, HMO, Medicare, Medicaid, and Coordination of Benefits (COB),Third Party Liability claim adjudication/adjustments. 
  • Knowledge of Medical Terminology, ICD-10, and CPT coding required.
  • Competent in Microsoft Office and PC skills. 
  • Ability to demonstrate organizational, interpersonal, and communication skills.

Licensure, Certifications, and Clearances:
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $19.13 to $31.92

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



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